Individual provider Active NPI

Dimitrie Cosmin Nastasa, DDS

  • General Practice Dentistry
  • Farmington, MI
National Provider Identifier
1154084671
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
2901601159 Issued in MI
Practice address
23023 Orchard Lake Rd Ste C
Farmington, MI 48336-3267
Phone
(248) 476-4619
NPI assigned
Oct 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2901601159 MI Primary

Addresses

Primary practice location

23023 Orchard Lake Rd Ste C
Farmington, MI 48336-3267

Mailing address

23023 Orchard Lake Rd Ste C
Farmington, MI 48336-3267
Phone (248) 476-4619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211208001248 MI Order and Referring Only - DentistPractitioner - Dentist 1759771629

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2901601159MIMDGeneral Practice Dentistry

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1634774400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1154084671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23023 ORCHARD LAKE RD STE C",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483363267",
            "telephone_number": "248-476-4619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23023 ORCHARD LAKE RD STE C",
            "city": "FARMINGTON",
            "state": "MI",
            "postal_code": "483363267",
            "telephone_number": "248-476-4619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NASTASA",
        "first_name": "DIMITRIE",
        "middle_name": "COSMIN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-21",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901601159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MI

Sources for this page

Verify at the official NPI Registry.